Inspection on 14/06/05 for Garthowen

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Garthowen 01/10/07

Garthowen 09/05/07

Garthowen 14/11/06

Garthowen 16/05/06

Garthowen 06/01/06

Garthowen 28/01/05

Garthowen 06/08/04

Garthowen 12/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Gavin Thomas Unannounced 14 June 2005 at 11.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Garthowen Version 1.10 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road, Chiswick, London, W4 4QP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 995 9702 oojundun@hotmail.com Maca Oluminde Ojudun Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 January and 14 February 2005 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is for service users with mental health problems and accommodates twelve people. The London Borough of Hounslow is the main purchaser and has block purchased seven of the bed places. The Registered Provider is the Mental After Care Association (MACA) who own and manage the home. The accommodation has nine single bedrooms on the first floor. There is a self contained flat with two single bedrooms on the second floor and an independent flat on the ground floor. Service users who are ready to move on to more independent accommodation use the latter. There is a large communal lounge with a television, video and stereo. This room is used as a smoking area. The dining room is comfortably furnished and can be used as a quiet area in between meals. This is a non-smoking area. There are no lifts in the building so it is suitable only for service users with good mobility. Service users are expected to participate in cooking, looking after their own laundry and helping with some domestic chores in house. After a settling in period, service users are expected to become involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support service users to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Garthowen Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place for the duration of 8 hours. The Inspector spoke with three service users and one member of staff. Two service users said they were satisfied with the provisions of service. The service users explained that they had responsibilities in the home such as cleaning, contributing to the preparation of meals and shopping. The service users were of the opinion that group support and support from the staff team were beneficial. Staff were described as being helpful and considerate. One service user expressed concerns about their mental health and what they thought to be contributing factors. The service user agreed for the Inspector to discuss these issues with the Registered Manager. The Registered Manager agreed to meet with the service user to offer support in solving some of their anxieties. Two service users completed surveys for the purpose of this inspection. Both service users indicated that they were satisfied with the service. This included care and support, involvement in decision-making and the quality of food. Both service users stated that they felt safe in the home. The home did not have copies of the National Minimum Standards for Care Homes for Adults (18-65) and the Care Homes Regulations 2001. The Inspector strongly advised the Registered Manager to obtain these documents and ensure that they are used in relation to the day-to-day running of the home. What the service does well: The service does well in providing an environment whereby service users with mental health needs are empowered and supported to re build their confidence and self - esteem. Spacious accommodation is provided which enables service users to spend time alone or with others. Service users spoken to said that the ethos of the home has helped to improve their quality of life. Garthowen Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Garthowen Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Garthowen Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 3 The home’s Statement of Purpose and Service User Guide is inadequate and does not provide sufficient information for prospective service users to be clear about the services the home provides to meet their needs. Thorough procedures were in place for the assessment and admission of prospective service users. EVIDENCE: A Statement of Purpose and Service User Guide were in place. The Statement of Purpose did not include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. The Statement of Purpose also contained a business plan, which was dated April 2003. The Service User Guide did not include all of the criteria as set out in Regulation 5 of the Care Homes Regulations 2001. The Registered Manager said that the Service User Guide had been updated but was not available for inspection purposes. An assessment is carried out with all prospective service users. Two assessments examined were detailed and informative. A draft letter has been devised for prospective service users informing them if the home is able to offer them a placement following assessment. This letter must be revised to clearly specify that following assessment, the home is able to meet the service users needs. The content of the letter does not fully meet this requirement from the previous inspection. External professionals support the home. The Psychiatric Nurse attends team meetings and provides training for the staff team. Staff receive induction Garthowen Version 1.10 Page 9 training and on going training in working with people with mental health needs. Specific procedures and restrictions were in place for service users admitted to the home under sections 37 and 117 of the Mental Health Act 1983. The Registered Manager said that service users were aware of these restrictions. Garthowen Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 & 9 Good care planning systems were in place. However, the frequency of reviewing risk assessments must be reviewed and increased. EVIDENCE: Care plans were in place for all service users. Three service users said they are involved in care planning meetings. This includes Care Programme Approach meetings, which are held every six months. Care plans are updated every six months and at other times when required. Changes to care plans are made in consultation with service users. Service users are consulted on the day-to-day running of the home. This is done via service users meetings, which take place daily. Tasks and chores are negotiated with service users in the daily meetings. These include meal preparation and cleaning. Policies and procedures relating to service users safety and welfare were displayed in the dining room. The Registered Manager said that one service user had suggested that service users are more involved in the process for admitting new service users to the home. The Registered Manager was of the opinion that this was a positive suggestion and a service users forum was under discussion to involve service users in this process. Garthowen Version 1.10 Page 11 Risk assessments were in place for all service users. Two risk assessments examined were detailed and well written. However, it was noted that both risk assessments were dated October 2004. Risk assessments must be reviewed and when necessary, updated more regularly. Garthowen Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 14 & 17 Links with the community are good. The systems for service user consultation are good with a variety of evidence that indicates that service users’ views are both sought and acted upon. EVIDENCE: The home offers a range of practical activities, counselling sessions and group therapy as part of the rehabilitation process. These include intermittent support from the staff, Key worker meetings, gender groups, video groups, music groups and monthly community meetings. Service users are encouraged to use their time constructively. Although individual programmes were in place, a community programme of activities, group sessions and meetings was not in place. This should be considered. Seven service users were engaged in daytime programmes in either voluntary work or attending day centres. Service users access the local community independently. Three service users spoken to said they were confident in going into the community independently. All service users arrange their own annual holidays. Group outings are negotiated in the gender groups. Places of interest include parks, museums and pubs. Garthowen Version 1.10 Page 13 Racial, cultural and diversity matters are discussed in community meetings. The Registered Manager said that one service user did raise concerns with regards to the ethnic mix of the staff group. Progress has now been made towards recruiting so that the ethnic mix of staff and service users is a better balance. Service users contribute towards menu planning and food preparation. A service user prepared the evening meal served on the day of this inspection. The Inspector sampled this meal. The meal was nicely presented and appetising. It was noted however, that the dinner plates were badly chipped and must be replaced for health reasons. Garthowen Version 1.10 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. General management of medication had improved, but the home must ensure that proper procedures are followed for the storage and administration of certain types of medication. EVIDENCE: The Registered Manager said that service users mental health needs were being managed with on going support from health care professionals. Service users are supported to make appointments and attend primary health care treatments. Support was also in place for service users to gain access to up to date information, advice and therapy about general health issues such as drugs and alcohol. Similar opportunities should be explored for other health promotion topics including HIV and Hepatitis. Medications were stored in a locked cabinet. It was noted however, that a separate locked facility was not provided for the storage of a controlled drug when this was being brought back to the home for administration once a week. The receipt and administration of this medication was not being recorded in a hardback register. Subsequent to this inspection, the Registered Manager confirmed that a separate lockable facility was obtained for the storage of this controlled drug on the 15 June 2005. Garthowen Version 1.10 Page 15 Five service users were self-medicating at the time of this inspection. Lockable facilities were provided in service users bedrooms for the storage of the medication. Pharmaceutical audits were not being carried out. The Registered Manager was advised that this must be arranged with a Pharmacist. Garthowen Version 1.10 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The complaints procedure was accessible to service users, staff and visitors. Systems for ensuring the safety and protection of service users were in place. However, further documentation must be obtained to ensure that correct procedures are followed for responding to suspected or known abuse. EVIDENCE: A complaints policy and procedure was in place. The complaints procedure was displayed on the notice board in the dining room. Three service users spoken to informed the Inspector of the procedures they would follow if they had any concerns. The complaints procedure was included in the Statement of Purpose and Service User Guide. Although the Registered Manager reported that the home had not received any complaints since the last inspection, a complaints record must be devised and implemented. The Registered Manager confirmed that staff had attended adult protection training within the last year. The home must obtain copies of the Department of Health No Secrets guidance document and the London Borough of Ealing Adult Protection procedures. The home’s adult protection procedures must be updated with procedural guidance for responding to suspected or known abuse. Garthowen Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The standard of décor in this home is poor with little evidence of improvement through maintenance or future planning. As a result, proper systems must be put in to place to improve the overall cleanliness and upkeep. EVIDENCE: Garthowen is a large detached house with accommodation over three floors. Parking spaces are provided at the front of the home. An enclosed garden with seating is situated to the rear of the property. The home is not suitable for service users who have physical disabilities and unable to climb stairs. A sleeping- in room is situated on the ground floor. Only the communal rooms were inspected on this occasion. Although comfortable furnishings are provided in the lounge and dining room, there are parts of the home, which requires attention as follows: • Stained flooring in the toilet on the ground floor. • A light fitting is required in the toilet area of the en suite bathroom on the ground floor. • Stained walls and carpet in the lounge. • Stained and chipped skirting boards and door frames in the hallway and communal rooms. Garthowen Version 1.10 Page 18 • Stained flooring in the utility room on the ground floor. • Complete redecorating in the kitchenette on the second floor. The front garden was overgrown and in need of attention. A stained glass window was broken in the bathroom on the ground floor. The Registered Manager said that he was in the process of finding a suitable contractor to replace the broken glass. A record of maintenance jobs undertaken was in place. In addition to this, a planned maintenance and renewal programme must be devised and implemented. Infection control policies and procedures were in place. Washing facilities are situated in a designated room on the ground floor. An assessment must be carried out to ensure that the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. Garthowen Version 1.10 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Training opportunities were available to the staff team. However, a proper training programme is required for the home. EVIDENCE: The Registered Manager said there have been no changes to the staff ratios. There are two staff on duty at all times during the day and one staff on a sleeping – in shift during the night. Induction and foundation training programmes were in place. Staff training and development needs are identified in one to one supervisions and annual appraisals. An organisational training programme for the period 2005 - 2006 was in place. The programme was detailed and included a wide range of training opportunities. However, a training programme for the home must be devised and implemented from the organisational programme. Further progress must be made for registering staff to undertake NVQ training. Garthowen Version 1.10 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 42 The Registered Manager is well established and has extensive experience in working with people with mental health needs. Health and safety systems must be reviewed for the reasons as set out below. EVIDENCE: The Registered Manager said that he is currently working towards the NVQ Level 4 in management and care. The Registered Manager said he operates an open door policy and works closely with staff and service users. The Registered Manager said that the home has received positive feedback from the Community Mental Health Team and relatives with regards to the service and the types of support available to service users. The Registered Manager confirmed that he receives professional supervision on a monthly basis. He also attends relevant training courses to keep abreast of current practices. Health and safety policies and procedures were in place. Garthowen Version 1.10 Page 21 A legionella test was carried out in April 2005. The results of this test were satisfactory. The Registered Manager said that the bathing and showering facilities were thermostatically controlled. Documentary evidence must be obtained to confirm this. Hot water temperatures must also be tested and recorded periodically for bathing and showering facilities. The electrical installation test was last carried out in July 1998. A further test must be arranged to ensure that this test done at least every five years. A Portable Appliance Test was carried out in April 2005. Fire risk assessments were last updated in March 2005. The fire detection system is tested on a weekly basis. Records examined confirmed this. A record of fire drills is maintained. However, this record must include the full names of staff and service users attending each drill, the time of the drill and the time taken for evacuation. In accordance with records examined, an approved contractor last tested fire appliances in September 2004. A further test of these appliances must be arranged. One oven was out of working order. The Registered Manager said that the home was waiting for the delivery of a replacement oven door. It was noted that the second oven door was unsafe and did not shut tightly. This door must also be replaced. The cookers, ovens and microwaves were in need of thorough cleaning. It was also noted that opened bags of flour were exposed in the cupboard. Although airtight containers were provided for opened bags of flour-based foods, they were not being used. Opened bottles of sauce were also stored in the cupboard. Once opened, these should be stored in the refrigerator. Cooked vegetables stored in the refrigerator must also be dated and labelled at all times. At the time of this inspection, the office door was wedged open. This is a designated fire door and this practice must cease. A suitable device must be fitted to the office door to ensure that it closes automatically should the fire alarm be activated. Garthowen Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 3 x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 Garthowen 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x x x 2 x Version 1.10 Page 23 16 17 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x Garthowen Version 1.10 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(1)(c ) Schedule 1 5(1)(a)(b) (c) (d)(e)(f) 14(1)(d) Requirement The Statement of Purpose must include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. The Service User Guide must include all of the criteria as set out in Regulation 5 of the Care Homes Regulations 2001. The draft letter to prospective service users must be more specific to confirm that the home can meet their needs. (Timescale of 31/3/05 Not Met). All risk assessments must be reviewed and where necessary, updated more regularly. Chipped dinner plates must be replaced. A hardback register must be obtained and used for the reciept and administration of controlled drugs. (Timescale of 1/3/05 Not Met). The home must arrange for regular Pharmaceutical audits to be carried out. A complaints record must be devised and implemented. The home must obtain a copies of the Department of Health No Version 1.10 Timescale for action 31/8/05 2. 1 31/8/05 3. 2 31/7/05 4. 5. 6. 9 17 20 13(4)(b) 13(4)(c ) 13(2) 31/7/05 31/7/05 14/7/05 7. 8. 9. 20 22 23 13(2) 17(2) Schedule 4 - 11 13(6) 31/7/05 31/7/05 31/7/05 Garthowen Page 25 10. 23 13(6) 11. 24 & 30 23(2)(d) 12. 13. 24 30 23(2)(b)( d) 13(4)(c ) 14. 15. 16. 35 35 42 18(1)(a) (c - i) 18(1)(a) (c -i) 13(4)(c ) 17. 42 13(4)(c ) 18. 19. 42 42 13(4)(c ) 23(4)(e) 20. 42 23(4)(c ) (iv) Secrets guidance document and the London Borough of Ealing adult protection procedures. The homes adult protection procedures must be updated with procedural guidance for responding to suspected or known abuse. The procedures for maintaining cleanliness and upkeep of the premises must be reviewed. An action plan must be provided to address the shortfalls as stated under the section titled Environment of this report. A planned maintenance and renewal programme must be devised and implemented. An assessment must be carried out to ensure that the services and fittings comply with the Water Supply (Water Fittings) Regulations 1999. A training programme for the home must be devised and implemented. Further progress must be made for registering staff to undertake NVQ training. Documentary evidence must be obtained to confirm that bathing and showering appliances are thermostatically controlled. Hot water temperatures for bathing and showering appliances must be tested and recorded periodically. Arrangements must be made for an electrical installation test to be carried out. The record of fire drills must include the full names of staff and service users attending each drill, the time of the drill and the length of time taken for evacuation. Arrangements must be made for the fire appliances to be tested Version 1.10 31/7/05 31/7/05 31/8/05 31/8/05 31/7/05 31/7/05 31/8/05 31/8/05 31/7/05 31/8/05 31/7/05 Page 26 Garthowen by an approved contractor. 21. 22. 23. 24. 25. 42 42 42 42 42 23(2)(c ) 16(2)(h) 16(2)(g) 13(4)(c ) 23(4) (c )(i) Both oven doors in the kitchen on the ground floor must be replaced. All cookers, microwaves and ovens must be thoroughly cleaned. Once opened, all flour and flour based foods must be stored in airtight containers. Cooked foods stored in the refrigerator must be dated and labelled at all times. A suitable device must be fitted to the office door to ensure that it closes automatically should the fire alarm be activated. Fire doors must not be wedged open. (Timescale of 31/3/05 Not Met). 31/7/05 31/7/05 14/7/05 14/7/05 31/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 12 19 42 Good Practice Recommendations A community programme should be devised and implemented. Service users should be offered additional up to date advice and information on health promotion topics such as HIV and Hepatitis. Opened bottles of sauces should be stored in the refrigerator. Garthowen Version 1.10 Page 27 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Garthowen Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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